COVID-19 Update from Dr. Smith: 5/06/20

Each day during the COVID-19 crisis, Dr. Craig Smith, Chair of the Department of Surgery, sends an update to faculty and staff about pandemic response and priorities. Stay up to date with us.

Dear Colleagues,

The single greatest preoccupation of our restart efforts is how to create the safest possible environment for our patients and ourselves. That preoccupation implies that we have some grasp of the incremental risk associated with leaving the outside world to enter our world. A person walking through our lobby, or any hospital lobby, certainly has a right to wonder how that transit impacts the risk of coronavirus infection. First, what is the person’s baseline risk, before entering the lobby? 177,000 infections have been confirmed in a population of 8.3 million in the five boroughs, which is an incidence of 21%. In Westchester County the figure is 22%. To be clear, incidence is not a synonym for risk. It is more like an outcome of risk, because incidence as calculated here doesn’t measure important elements of risk like intensity of exposure and individual susceptibilities. Nonetheless, I’ll use incidence as a stand-in for risk because it’s about all we have.

Returning to our lobby, how many of the health care workers surrounding our visitor have been infected? We don’t know, and we are only beginning to do the kind of testing that can quantitate that incidence. Reports on first-responders indicate that 15-20% have been infected. Our providers probably face approximately similar exposures. Note that we are now well into the declining phase of the new-case curve—would 15-20% apply if remeasured today? Jump to an extreme, and ask how many providers in our Covid ICUs have been infected. Again, we don’t know, but I would be very surprised if it proves to exceed 20%. It is hard to imagine that our visitor’s exposure is comparable to the exposure of ICU providers, but I’ll peg that estimate as a ceiling, to be conservative. In summary, our visitor left a ~20% risk environment and entered a ~20% risk environment, and both figures are likely much lower today. I am overworking these crude approximations to emphasize that there is very little we really know, yet we must be as ruthlessly factual as possible in estimating the incremental risks we’re attempting to mitigate. Our countermeasures may be complicated, off-putting, and expensive. All institutions risk a ruinous arms-race over “safety” when we hardly know what that means. Superstitions we enshrine now may take years to lose their grip.

Today is Nurse’s Day. This year it should have been combined with Mother’s Day and Father’s Day, because nurses have been that important in our battle with Covid-19. In an earlier message I compared nursing to the thickest part of a dam, where the pressure is greatest, the part that prevents drowning and devastation by not breaking. It was the absence of nursing expertise that concerned me the most in the ORICUs during the worst of the surge. We had master planners, and MDs aplenty covering the top half of the dam. At the nursing level we had a few trained ICU nurses and large numbers of OR and PACU nurses doing things they had never been trained to do. Yet learn they did, and do they did, for our patients. This week I received an email from one of my regular OR nurses: “It is truly amazing what has been done in the ORICU - I am simply blown away by the team work….These last few weeks have been life altering. I wish I had not missed two of them while out ill.” She ended with Bob Marley: "You never know how strong you are, until being strong is the only choice you have."

Craig R. Smith, MD
Chair, Department of Surgery
Surgeon-in-Chief, NYP/CUIMC

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